Investigation of bacterial prevalence, antimicrobial resistance patterns and associated factors in skin and soft-tissue infections at Jinja Regional Referral Hospital: A retrospective study from 2019-2021

Abstract

Skin and soft tissue infections (SSTIs) are commonly encountered cases of hospital-acquired infections. Some aetiologic agents exhibit antimicrobial resistance rendering treatment of skin and soft tissue infections ineffective. This results in delayed wound healing, longer hospital stays, and higher costs all associated with higher morbidity and mortality. This study determined the prevalence of SSTIs and the proportion of suspected cases that underwent laboratory investigation. It also determined the antimicrobial resistance profile of aetiologic agents and risk factors associated with SSTIs and multidrug-resistance (MDR). This study was based on archived data from 2019 to 2021 of patients suspected of SSTIs at Jinja Hospital. Out of 961 patient reports, 268 were randomly selected for analysis. The prevalence of SSTIs was 66.4% (95% CI = 60.7-72.1) with 44% being nosocomial. Suspected SSTIs that underwent laboratory investigation were 14.11%. Staphylococcus aureus (n = 51) was the most isolated organism. Gram-negatives were the most dominant group. Multidrug-resistant (MDR) pathogens were altogether responsible for 47% of infections. Methicillin-resistant S. aureus (MRSA) was up to 44%. Meanwhile, 61% were possible extended-spectrum beta-lactamase (ESBL) producers, and 27% were carbapenem non-susceptible organisms. Staphylococcus aureus isolates were most sensitive to gentamicin and ciprofloxacin. Enterobacterales were most susceptible to gentamicin, chloramphenicol, and imipenem. Ward of admission was significantly associated with infection (aPR=1.78, 95% CI: 1.003-3.18, p-value = 0.04). Age category was an independent predictor for MDR infections (aPR=2.30, 95%CI:1.02-5.23, p-value=0.04). The prevalence of SSTIs is relatively high with MDR pathogens responsible for almost half of the infections. Routine screening of admitted patients by culture and sensitivity testing should be used for proper infection management. Gentamicin and ciprofloxacin should be used for empirical management of SSTIs suspected of S. aureus. Wound swabs and pus aspirates should be considered among priority samples for the Global Antimicrobial Resistance and antimicrobial use Surveillance System (GLASS).